Revised: January 9, 2009

The New Year of 2009 is here and in full blossom. With the ever-rising rates of obesity in our country and throughout the world, I am going to take a guess and say the most common resolution at the beginning of 2009 was to lose weight. Just a guess, but I think I will be in the ballpark of most "Top 10" lists. To be sure, New Year's Day is not the only day you can make a "resolution." You can make a resolution to live a healthier lifestyle any day, week or month. Make a "birthday resolution" or an "anniversary resolution." What's wrong with a "4th of July resolution?"  Resolve, any day you want, to live healthier and achieve a healthier body weight. But, tradition being what it is, now is the time to make the promise. The promise to yourself - and no one else - that you are going to live a healthier, more active and happier year.

Since I have dedicated my medical practice for well over a decade to guiding patients through this challenging process, I am going to offer some advice. The advice is based on several sources that include:

• Personal Experience - I was one of those kids that always had the word "Husky" on his blue jeans as an adolescent. The pant legs were always too long. I distinctly remember I had to have a license as as 12 year old to have a newspaper route. The "vital statistics" on the license said I was 5' 4" and weighed 175 pounds. I didn't think anything about it at the time, but I remember it today. I was never "picked on" as a child, I do remember that. I had much too short a temper for anyone to taunt me. In high school, I slimmed down and grew into my frame. I was a lineman on the football team, threw the shot put and discus in track, and wrestled in the 190 weight class. I was physically active. Then came college. The only activity I had was walking back and forth to campus. I gained weight, but not a lot. Probably because I had to cook my own food. Mostly canned foods and rice. (We were not a wealthy family; both parents worked to afford the tuition). I also worked in the Biology Department on weekends. Then came marriage, medical school, and fatherhood. I gained a little more weight. Next, during my internship and residency - a stressful but very sedentary period in my life - I ballooned up to 250 pounds (in retrospect, my BMI was 37 - clearly, in the "obese" category). Now, loosely packed on a statuesque 69" frame (I was one who explained my weight as being a victim of being "big boned" or, for the non-Southerner, "large framed"), I was big. I sported a 40" waist and wore an size 44 jacket. I shopped off the leftover tables because, at least back then, they were not a lot of clothing manufacturers cranking out 40 X 30 (30" was my inseam) pants. I notice that it is not so hard to find these sizes any more. The market for them must have improved. I remember I always wore an oversized white coat because, in the deluded mind set of an obese person, I thought it would visually "slim me down." Anyway, to make a much longer story short, when I turned 50, I decided enough was enough. I have lost the weight and have kept it off. Having had a heart attack at age 34 and a quadruple coronary bypass at age 42 was more than enough encouragement. Now, I proudly have a 32" waist (which I didn't even have as a high school athlete) but, sadly, I am still only 5' 9" tall - if only there was a way to reach six feet! By the way, I no longer wear a white coat, ever. Not even in my medical clinic. The point is: genetics can be overcome and hard work does makes a difference on the battle against obesity. Genetics may cock the trigger for being overweight, but is your lifestyle that pulls the trigger.
  

• Professional Experience - I have been treating overweight (I guess I should use the more politically correct "weight challenged" but being "PC" will be the topic for a future rant) patients for over 10 years now. I can pretty much spot the ones that will succeed in losing weight usually with our initial evaluation. Just talking to patients gives you an idea of their motivation. Also, you can get an idea of how badly damaged their ideas about weight loss are. Sometimes I get fooled; usually, after 6 weeks, I sadly see I was right. Losing weight is a lot like quitting smoking. When you are ready, you will do it. Before that point, no matter what you hear or are prescribed, you won't. It's like a light switch. It's either off or on. Being ready - truly ready - to lose weight is (as I throw out yet another metaphor) like being pregnant. You are or you are not.

• Research - I have pretty much read everything there is to read - both in the lay literature and in the medical journals - about losing weight. It all basically says the same thing and that is what I advise in my clinic and what I will advise here. Early in my medical career I was taught the doctor's mantra in the late 80's and early 90's - people are obese because they eat too much. My advice to the desperate people asking my medical advice was: "Just push yourself away from the table and you will lose weight." What I was saying was: "It's your lack of self-control that is your problem. Quit being a glutton!" I was wrong and, the more I read about obesity, the more I realize how wrong I was. Obesity is a complex problem with genetic, physiological and behavioral components. And, since it has so many components, it is is truly difficult to treat. However, it can be treated. That said, let's get started.

1. What diet do I recommend you follow? Here is the first of, probably, many "shocking" answers: I don't care. If you believe in and want to follow one of the low carbohydrate diets - such as the Atkins or South Beach diet - that is fine with me. I can't really get behind any diet that sells you pre-packaged foods (Jenny Craig, Weight Watchers, etc.) because the prices are too high and it is not a permanent solution for a very permanent problem. Most people are not willing to buy their groceries at such exhorbitant prices for the rest of their lives, save Oprah and I doubt even she would do it forever based on past observations with her weight cycling. My personal and professional preference is a low fat diet. I recommend a diet with no more than 30 grams of fat per day. The remainder of your diet may be split into carbohydrate and protein depending on your personal tastes. Some people enjoy meat - protein -and that is fine. Chicken or fish and baked or broiled are best but, heck, you can have beef too if it is lean and not heavily marbled with fat. If you like hamburger, buy ground sirloin or chuck rather than the 50% fat standard hamburger at the meat counter. Fried foods are to be avoided at all cost. Some people like breads, rice and cereal - carbohydrates. I do not put any restrictions on these. My point is: any diet will work if you follow it and exercise regularly. I am more concerned with your activity level than I am with what you eat. All diets share one common thing- they are reduced in total calories. They differ only in what foods make up the calories you do eat. You can follow your personal food preferences in selecting your diet. After all, this is how you are going to eat the rest of your life. So chose an eating plan you can follow for the rest of your life for that is how long problems with controlling your weight will last. Editorial Follows: I hate the word "diet" because it means, to most people, a temporary "fix."The thinking goes "I will follow this diet for 6 months, lose my weight and then go back to what I was eating before." Do I need to tell you what the inevitable result of this approach is? When you stop your diet, and resume your usual eating habits, you will gain back at least 125% of what you have lost. Notice, I didn't say 100% - I said 125%. Obesity if not like a cold. It cannot be treated for 6 months or until you lose your weight. If you think you are "cured" you will regain your weight. Obesity is a disease, much like diabetes or high blood pressure. It cannot be cured - only controlled. You are making changes toward a permanent lifestyle, not a temporary change in habits. In order to keep weight off, you will have to be conscious of the being prone to gain weight - just like a diabetic is conscious of their blood sugar - all your life. If you have been overweight in the past, you will always be "pre-obese." The minute you turn your back and stop doing those things that are necessary for healthy living (exercising, sensible eating, time management, etc.), you will regain your weight again. Few things in life are more certain than this. We discuss these concepts in detail at this site on our site.

2. What should you do for exercise? It is my strong belief, born out of a lifetime of personal and a decade of professional experience and observation, that exercise is the cornerstone of any successful weight control program. Following a structured, semi-controlled eating plan - better known as a diet - will certainly help you lose weight. But the only behavioral change that can guarantee that you consistently lose weight and keep weight off is to become more active in your daily life. You simply cannot avoid it - if you want to lose weight, you must exercise. Now, as to what exercise is the "best," it is very much like which diet is "best." Here's your rule: The best exercise for losing weight is the exercise that you actually enjoy doing and have the opportunity to do on a regular basis. It's like (another metaphor) murder investigations.You look for motive, opportunity, and method.

• Your motive is to lose weight and, ultimately, to keep weight off. Simple enough. -
• Opportunity is making the time to exercise. Yes, I know you are busy. We all are. Yes, I know. You have a job, several small children and a really demanding spouse. Yada, Yada, Yada! I would hope you have enough self-esteem and sense of self-worth that you believe you could and should spare 3-4 hours per week to making yourself more fit and energetic. With the energy you get from exercise and by simply being more fit, you will take care of all your responsiblities better..
• Method is the tricky one. If you would love to cross-country ski for exercise and live in Alabama, that is probably unreasonable. ["Probably" because you could get some roller blades and ski poles and "ski" all over your neighborhood] If you want to swim and live in Montana, that may be difficult as well. Seek an opportunity and method of exercise that is easy to get started doing and to keep doing. The simplest is just walking. If you can't get outside, for whatever reason, then use an exercise video. My patients really like the "Walk Away the Pounds"© video series. If you have arthritis and walking aggravates your joints, you should try an exercise bicycle, CardioGlide™ (or AirWalker™), or rowing machine. They are all basically equal in effectiveness and easier on damaged joints than treadmills.

3. Why Should I exercise? What happens when you don't exercise, and you starve (diet) for a few weeks and do manage to lose a few pounds?Here's what happens: you may lose body weight but what you have lost, research shows, is usually 50% fat and 50% muscle. If you have starved off 10 pounds, congratulations! You have just lost 5 lbs of fat and 5 lbs of muscle. Now, guess which body tissue most determines your resting metabolism and, ultimately, how likely you are to keep this weight off. If you guessed your muscle mass (or "lean body mass"), you're right! Fat tissue is metabolically inactive and burns very few calories during a normal day's activities. Muscle tissue is very metabolically active and uses calories all day, even when you are not exercising. If you lose muscle, your metabolism drops proportionately. [Parenthetically, that explains why men usually lose weight faster than women. Men, genetically and morphologically, have a higher muscle mass and, thus, a higher metabolism than a woman of equal weight.] So, what have you accomplished by starving off this 10 pounds" You have lowered your metabolism and, thus, made it even harder for you to keep the weight from coming back. This is the much publicized "Yo-Yo Dieting" (or, medically, weight cycling) problem. Most people have done this over years and years - lost and regained, lost and regained - that, when they get in their 40's and 50's, they find it increasingly more difficult to lose weight. Why is that? Simple. It is because they have lost muscle mass every time they have lost weight through starving (diet) without exercise. Now, they have reduced their metabolism to that of an amoeba and they couldn't lose weight if they ate two crackers a day. If they would start exercising to build their muscle mass back up, they would probably be able to lose weight again. But only with improving their lean body mass which, in turn, improves their metabolism. We have an entire discussion on the importance of exercise at this site on our web.

4. Does any type of exercise actually improve my metabolism? I am glad you asked! While most people concentrate on aerobic exercise while losing weight, this is not really an optimal plan. Aerobic exercise got it's good reputation due to well-publicized authors like Kenneth Cooper and by the myriad celebrity videos. [Rhetorically, I ask: If you are a celebrity, surely you must know how to exercise properly, right? I mean who knows more about exercise than Jane Fonda, Suzanne Summers, or Carmen Electra? I can't think of a single person, can you? By the way, I say that with a smirk and a large portion of sarcasm] I will freely admit aerobic exercise, such as walking, swimming, jogging, etc., is useful for general health and well-being. But I am also firmly convinced that, in order to increase your chances for long-term success, anaerobic exercise should be included in any exercise regimen. Anaerobic exercise is work that requires your muscles to work against resistance. As an example, weight lifting is anaerobic exercise. Pushups and sit-ups are anaerobic. Anaerobic exercise builds muscle mass and, thus, improves metabolism. Therefore, if you are 25 and are losing weight for the first time, you can probably stick with aerobic exercise and preserve your muscle while you lose weight. However, if you are in your 40's or 50's and have lost and regained weight more than 2 or 3 times in your life, you would probably benefit from 2-3 sessions per week of anaerobic exercise.

5. How much weight should you expect to lose? Healthy weight loss is not 30 pounds in 30 days. Healthy weight loss occurs when the body can burn fat without sacrificing muscle. If you drastically cut calories to less than the body needs, the body will burn energy from any source it can find. Available sources are protein (i.e. muscle) and fat. In starvation mode (i.e. a diet), the body will burn fat as easily and as readily as protein. That is why exercise is so important during weight loss. If you are exercising and using your muscles, the body will concentrate on burning only fat for energy. You will preserve your muscle mass and how much muscle you have determines your metabolism. If you are exercising and cutting back on calories to a healthy level, you should reasonably expect to lose 1 -2 pounds per week. If you have 100 pounds to lose, you should plan on a year of consistent exercise and calorie reduction. In order to lose one pound per week, you only have to reduce your daily calorie intake by 500 calories per day [specifically, there are 3500 calories in a pound of fat tissue; reduce calories 500 calories per day for 7 days and, eureka!]. That will result in one pound of fat loss per week - if you are exercising. Don't be in a hurry! If you have gained weight for five years, you shouldn't expect to lose it in 2 months. As you probably already know: it's a lot easier to gain weight than it is to lose it. Be patient. Slow and steady wins the race.

6. Do diet pills work? Equivocally, yes. Why do I equivocate? Because the current generation of medications(phentermine, phendimetrazine, diethylpropion) can be useful to give you an "energy boost"when initiating an exercise program. They also, at least for a few weeks, will help get your appetite under control. But the energy and the appetite suppression are short lived. They are useful and, I might add, safe for initiating a medically-supervised weight loss program. There is no longer any "Phen-Fen" to worry about. Phentermine and the other medications mentioned have all been available by prescription since the 1960's and have never been taken off the market.They have withstood the test of time. But they are not the key to a successful weight loss program. The keys to weight loss are, in order of importance, personal motivations, exercise and reasonable , healthy eating. More on this is located here on our web site.

Well, there it is, folks. The main point is you can make a resolution any time you want. If you decide, any time in 2009, to make a resolution to lose weight, you can do it! If you are overweight right now, don't wait until another New Year to make a decision to improve your health! I hope you have found this information useful.

Good luck and continued good health!